Dental Tribune Pakistan Edition No.1, 2017

DENTAL HYGIENE Infection control in an era of emerging infectious diseases 2017(cid:9) Pakistan Edition(cid:9)DENTAL TRIBUNE(cid:9) 7 January By Eve Cuny M ore than three decades have passed since the emergence of human immunodeficiency virus (HIV) as a global pandemic. More than any other infection, it is possible to single out HIV as the primary stimulus for changing infection control practices in dentistry. Prior to the mid-1980s, it was uncommon for dentists and allied professionals to wear gloves during routine dental procedures. Many dental clinics did not use heat sterilisation, and disinfection of surfaces was limited to a cursory wipe with an alcohol-soaked gauze sponge. This was despite our knowledge that hepatitis B virus (HBV) had been spread in clusters in the offices and clinics of infected dentists and that dentists were clearly at occupational risk for acquiring HBV. Today, many take safe dental care for granted, but there is still reason to remain vigilant in ensuring an infection-free environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinical environment using the same precautions as those e ff e c t i v e f o r p r e v e n t i n g t h e transmission of HBV and hepatitis C v i r u s . [ 1 ] T h e s e s t a n d a r d precautions include the use of personal protective attire, such as gloves, surgical masks, gowns and protective eyewear, in combination w i t h s u r f a c e c l e a n i n g a n d disinfection, instrument sterilisation, hand hygiene, immunisations and other basic infection control precautions. Sporadic reports of transmission of blood-borne diseases associated with dental care continue, but are most often linked to breaches Infection control in the dental practice includes washing hands, wearing gloves, using disposable supplies, and disinfecting reusable materials properly. i n t h e p r a c t i c e o f s t a n d a r d precautions.[2](cid:9) E m e rg i n g a n d r e - e m e rg i n g infectious diseases present a real challenge to all health care providers. Three of the more than 50 emerging and re-emerging infectious diseases identified by the Centers for Disease Control and Prevention and the World Health Organization (WHO) include Ebola virus disease (EVD), pandemic influenza and severe acute respiratory syndrome.[3, 4] These previously rare or unidentified infectious diseases burst into the headlines in the past several years when they exhibited novel or uncharacteristic transmission patterns.(cid:9) Concern about emerging infectious diseases arises for several reasons. When faced with a particularly deadly infectious disease such as EVD, which can be spread through contact with an ill patient's body fluids, health care workers are naturally concerned about how to protect themselves if an ill patient presents to the dental clinic. With diseases such as pandemic influenza and severe acute respiratory syndrome, which may be spread via inhalation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be adequate.(cid:9) In addition to standard precautions, treating patients with these diseases requires the use of transmission-based precautions. These encompass what are referred to as contact, droplet and airborne precautions for diseases with those specific routes of transmission. Transmission-based precautions may include patient isolation, placing a surgical mask on the patient when he or she is around other people, additional protective attire for care providers, and in some cases the use of respirators and negative air pressure in a treatment room. In most cases, patients who are contagious for infections requiring droplet or airborne precautions should not be treated in a traditional dental clinic setting.(cid:9) Updating a patient's medical history at each visit will assist dental health professionals in identifying patients who are symptomatic for infectious diseases. Patients with respiratory symptoms, including productive cough and fever, should have their dental treatment delayed until they a r e n o l o n g e r s y m p t o m a t i c . A d d i t i o n a l l y , h e a l t h c a r e professionals who are symptomatic should refrain from coming to work until they have been free of fever without taking fever-reducing medication for 24 hours.(cid:9) In most cases, a patient with symptoms as severe as those experienced with EVD will not present for dental care and therefore e x t r a o r d i n a r y s c r e e n i n g a n d p r o t e c t i o n p r o t o c o l s a r e n o t recommended. If a patient is suspected of having a highly contagious disease, he or she should be referred to a physician, hospital or public health clinic. (cid:9) t h a t Dental professionals should take action to remain healthy by being vaccinated according to accepted p u b l i c h e a l t h g u i d e l i n e s , u n d e r s t a n d i n g t h e r e c o m m e n d a t i o n s m a y d i ff e r according to country of residence. Performing hand hygiene procedures at the beginning of the day, before placing and after removing gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all positive actions that help prevent occupational infections. In addition, cleaning and heat sterilisation of all instruments and disinfection of clinical surfaces ensure a safe environment for patients. There is solid evidence that dental care is safe for patients and providers when standard precautions are followed, but patients and dental health care workers are placed at risk when precautions are compromised and breaches occur. DT Dental Hygiene USA Non-surgical laser ... Continued from front page the 24-hour-a-day improvement in airway vs. CPAP and MAD.(cid:9) N I G H T L A S E u s e s t h e photothermal capabilities of the LightWalker laser to convert and initiate the formation of new and more elastic collagen.[6] The target mucosal tissues are the oropharynx, soft palate and uvula. The proprietary "Smooth Mode" pulse characteristics create a non-ablative heat generation or "Heat Shock" that initiates the conversion of existing collagen to more elastic and organized forms and also initiates "neocollagenesis," the creation of new collagen.(cid:9) This process results in a visible elevation of the soft palate and uvula and tightening of the oropharyngeal tissues, resulting in an improvement in the upper airway volume. The results can be seen in Figures 1 and 2.(cid:9) NIGHTLASE therapy is indicated for cases when the patient has been diagnosed with chronic snoring, UARS or mild to moderate sleep apnea and either cannot or chooses not to wear an appliance or CPAP device. It can also be used in co- therapy with those devices, allowing for lower CPAP pressures and less MAD advancement. NIGHTLASE represents a less-invasive alternative to current surgical, chemical or radiosurgical options that may require hospitalization, general anesthesia or soft-tissue removal.(cid:9) NIGHTLASE has a significant success rate in producing a positive change in sleep patterns. Research published by Miracki and Visintin[7] has shown that it can reduce and attenuate snoring, and provides an effective non-invasive modality to lessen the effects of obstructive sleep apnea. As with any treatment, there are potential risks with laser treatment. However, the risks are minimal and certainly less then alternative therapies if the protocol is followed correctly. NIGHTLASE therapy is not a permanent alteration and lasts anywhere from six to 12 months and is easily touched up at f o l l o w - u p a p p o i n t m e n t s . [ 2 ] (cid:9) In 2013 we completed a pilot study that addressed only snoring with 12 patients. Twelve-month follow-up showed a 30-90 percent reduction in snoring tone and volume (Fig. 3). The lower percentages were smokers, obese patients and those with severe OSA. Follow-up studies with polysonography using HST are in process, as are pharyngometer studies, both of which have recorded s i g n i f i c a n t p o s i t i v e c h a n g e s . (cid:9) A recently published pilot research study by Lee and Lee[8] has shown through 3-D CT imaging the volumetric positive changes after NIGHTLASE treatment to help support the clinical results, and the authors have follow up studies with 3-D CT, polysonography and a larger group of patients in process. We are excited to present these modern, minimally invasive and more natural treatment modalities to the dental community. Using the LightWalker laser, we can now have another tool in our dental toolbox and offer our patients health improvements that reach beyond restorative and rehabilitative dentistry.(cid:9) If the reader is curious about using the NIGHTLASE protocol or about laser dentistry in general, you can contact the manufacturer for more i n f o r m a t i o n . A s a l w a y s , w e recommend a good variety of advanced educational programs in dental sleep medicine to see where NIGHTLASE might fit into your patients' treatment protocols. DT , General Dentistry Canada

Dental Tribune Pakistan Edition No.1, 2017

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